Hepatocellular carcinoma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]

Overview

MRI may be helpful in the diagnosis of hepatocellular carcinoma.

Common findings of hepatocellular carcinoma on MRI:^[1]

On T1-weighted MR images, hepatocellular carcinoma is most often hypointense relative to the liver, although hyperintense lesions or areas of hyperintensity within hypointense lesions may be seen.
- These hyperintense regions within the hepatocellular carcinoma reflect the presence of fat, copper, protein, or blood secondary to intralesional hemorrhage.

On T2-weighted images, hepatocellular carcinoma is generally hyperintense, although well-differentiated lesions that are isointense relative to the liver parenchyma may be seen.
Most hepatocellular carcinomas show intense enhancement on arterial phase contrast-enhanced images.
A large hepatocellular carcinoma (>5 cm) may have a number of characteristic features, such as a mosaic pattern, a tumor capsule, extracapsular extension with formation of satellite nodules, vascular invasion, and extrahepatic dissemination, including lymph node and distant metastases.
- The mosaic pattern is created by confluent small nodules separated by thin septa and necrotic areas within the tumor. This pattern is more often depicted on T2-weighted MR images than on T1-weighted images.